| NPI | 1104125533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: FL ME125715) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57.019585) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2022-07-21 |